Abstract

HIV is one of the worst pandemics in recent times, having affected more than 70 million and with a mortality rate close to 50%. Antiretroviral drugs fight viral replication and has improved life of HIV infected patients since it was introduced. Although ART has the potential of transforming the fatal disease into a chronic condition, there are critical issues surrounding access, adherence and resistance to the dug. We have systematically studied these questions and proposed a way forward to make ART more effective. The first study explores the stock-out experience in two districts in rural Tanzania at the time when ART decentralization had just taken place. Out of stock was not a strange phenomenon with all sites have experienced stock-out of HIV test kits. The patients in the CTCs experienced HIV drugs and cotrimoxazole stock-out in the year preceding the study. Some of the strategies used appear to aggravate problems. The adherence studies were showed parental caretaking a strong predictor of adherence in children and poverty and proximity playing acted as barrier to optimal adherence. ART adherence reporting overtime shows, patients tend to have better adherence during agricultural season. De-stigmatization campaigns and Direct Observed Therapy (DOT) interventions to children at risk of non-adherence are may improve adherence. In our last study on predictors of ART resistance, children were more likely than adults to have resistances mutations. This might be linked with either the previous use of a single dose nevirapine and/or with non-adherence as observed in the adherence study. Improving adherence and low cost viral load monitoring may be appropriate solutions.